Prepare for 5 key coding opportunities
The calendar may say the ICD-10 transition is long gone, but practices still will likely feel its repercussions in 2017 in terms of payer requests, denials and the new code set’s influence on value-based care. Looking to the rest of the year, practices should start being proactive with these coding opportunities now to consider how the following five factors will impact documenting, coding and billing for care:
While accuracy has always been essential, its importance is unparalleled now due to two developments: the increased specificity of ICD-10, and the quality improvement requirements of value-based care models.
Rather than trying to save time (and creating a billing compliance risk) by using a cut-and-paste documentation approach, a better strategy is to enable physicians to quickly capture discrete data in the electronic health record by using the software’s advanced documentation functionality while offering the flexibility to add unstructured notes when necessary.
Perhaps the best indicator that a practice is documenting, coding and billing accurately can be found in its claim denial rate. If physicians are seeing denial rates grow from their pre-ICD-10 baselines they should conduct a careful assessment of how their care teams are capturing data and how coders and billers are accessing that data and billing for services.
Although denial rates may have stabilized since the ICD-10 transition, do not be surprised if they escalate again as payers now have close to a year of ICD-10 data and begin to develop more aggressive medical necessity models.
It’s critical that practices understand the Medicare Access and CHIP Reauthorization Act of 2015
(MACRA)-and more specifically, the Merit-based Incentive Payment System (MIPS). According to the Deloitte Center for Health Solutions 2016 Survey of US Physicians, 50% of physicians say they have never heard of MACRA.
Practices should task their revenue cycle staff with understanding MACRA/MIPS and setting practice policy. The MACRA/MIPS leader can gather instructional information about the program to educate the practice and meet the law’s requirements.
ICD-10, MACRA/MIPS and value-based care models generally require practices to take a more sophisticated approach to revenue cycle management than ever before. Elevating staff expertise to a higher level of coding and billing knowledge is necessary, but doesn’t need to be tackled alone. So many changes are occurring so rapidly that little seems to get easier for providers actually trying to care for patients. By working together as a team, practices can drive improvements in coding.
In everything from data capture to patient care, all responsibilities can no longer fall solely on physicians’ shoulders. Implementing workflows that allow clinical support staff to understand and share documentation duties can alleviate some of the burden on physicians.
By preparing for these coding opportunities, physicians and clinical staff will have an easier transition. Practices as a whole will see an improvement in patient care and fiscal health.
Nancy Gagliano, MD, is chief medical officer and Randy Jones, DHA, is senior vice president for management consulting services for Culbert Healthcare Solutions Send your coding and billing questions to firstname.lastname@example.org.